Maximum Daily Dose of Cinnarizine
The maximum recommended daily dose of cinnarizine is 100 mg per day, administered orally in divided doses. 1
Standard Dosing Guidelines
The FDA-approved dosing range for cinnarizine is 25 mg to 100 mg daily, with the specific dose determined by clinical response and administered in divided doses throughout the day. 1
Typical Dosing Regimens in Clinical Practice
For vestibular disorders and vertigo: Studies have utilized 75 mg twice daily (150 mg total daily) for acute treatment periods of 7 days, though this exceeds the standard maximum recommendation. 2
For motion sickness prophylaxis in children: 15 mg administered 2 hours before travel, with an additional 7.5 mg (half-tablet) every 8 hours as needed. 3
Fixed-combination therapy: When combined with dimenhydrinate, cinnarizine 20 mg three times daily (60 mg total) has demonstrated superior efficacy compared to higher monotherapy doses. 4
Important Clinical Considerations
Dosing Above Standard Maximum
While the FDA label specifies 100 mg/day as the maximum, 1 clinical studies have employed 150 mg daily (75 mg twice daily) for short-term treatment of acute vestibular disorders with acceptable tolerability. 2 However, a single 150 mg dose in healthy volunteers produced detectable vestibular depression on electronystagmography, suggesting this higher dose has more pronounced central effects. 2
Pediatric Overdose Risk
Extreme caution is warranted with dosing in children, as a case report documented severe toxicity (stupor, convulsions) in a toddler who ingested 225 mg—resulting in serum levels 26.9 times higher than therapeutic adult levels. 5 The neurologic complications included CNS depression and seizures, likely related to cinnarizine's antihistaminic and antidopaminergic properties. 5
Pharmacokinetic Profile
The plasma elimination half-life of cinnarizine is approximately 3.24 hours following standard oral dosing, 6 which supports the divided dosing approach throughout the day for sustained therapeutic effect.
Safety Profile at Recommended Doses
At the standard maximum of 100 mg daily or below, cinnarizine is generally well tolerated with minor side effects including:
- Slight somnolence (26% of patients) 2
- Mild headache (11% of patients) 2
- Transient abdominal discomfort (11% of patients) 2
The key clinical pitfall is exceeding 100 mg daily without clear justification, as higher doses increase the risk of CNS depression, extrapyramidal symptoms, and in pediatric patients, seizures. 5 When doses above 100 mg are considered for refractory vestibular symptoms, limit duration to 7 days and monitor closely for neurologic adverse effects. 2